1083770234 NPI number — LUXOTTICA RETAIL NORTH AMERICA INC

Table of content: (NPI 1083770234)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083770234 NPI number — LUXOTTICA RETAIL NORTH AMERICA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUXOTTICA RETAIL NORTH AMERICA INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SEARS OPTICAL #C0174
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083770234
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4000 LUXOTTICA PL
Provider Second Line Business Mailing Address:
ATTN MEDICARE DEPT
Provider Business Mailing Address City Name:
MASON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45040-8114
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-721-6840
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3100 HWY 365
Provider Second Line Business Practice Location Address:
CENTRAL MALL
Provider Business Practice Location Address City Name:
PORT ARTHUR
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77640-7724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-721-6840
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
UHLS
Authorized Official First Name:
WENDY
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICARE ADMINISTRATOR
Authorized Official Telephone Number:
513-765-3534

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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